Results of treatment of myocardial infarction with ST-segment elevation using early and delayed coronary interventions in different age groups

The aim of the study was to assess the treatment results in patients with anterior STEMI using primary PCI in different patient age groups, including those at late hospitalization, taking into account the initial mortality risk (MR). The study included 804 patients with anterior STEMI, aged 28 to 91 years, who were admitted to N. V. Sklifosovsky Research Institute for Emergency Medicine in the period from 2008 to 2017: 583 of them had the primary PCI performed either within the first 12 hours from the disease onset (311 patients) or at late hospitalization: after 12–72 hours (272 patients); and 221 patients treated without PCI. The distribution of patients by age: under 65 years old, 65–75 years old, and over 75 years old was 340, 139, and 104 in the PCI group, and 126, 47, and 48 in the group without PCI, respectively. In 26 death cases after PCI and in 39 of died without interventions, the state of the coronary bed, the affected area, and the immediate cause of death were determined. We have found that in the absence of reperfusion therapy (RT) in STEMI, the initially high baseline MR assessed by TIMI Risk Score corresponds to high mortality. It affects people of predominantly elderly and, especially, senile age, who more often have a proximal lesion of the main coronary arteries, which causes an extensive area of infarction with the development of fatal complications. The use of primary PCIs, including those at late hospitalization, prevents the progression of acute heart failure, the formation of LV aneurysms, and reduces the deaths rate. In different periods of time, the mortality rate with the use of primary PCI, including the delayed ones, fluctuates; it can rise with a significantly increasing number of the hospitalized at senile age. An increase in mortality is associated with complications, including those arising during procedures in severe multivessel coronary artery disease, which is more common in this patient population. Achieving angiographic success even in the absence of ECG signs of reperfusion can significantly reduce mortality in all age groups. High MR is an optimal indication for using delayed procedures. An urgent use of primary PCIs, including those at late hospitalization, allows the optimization of the STEMI treatment, and the achievement of the maximum reduction in mortality.

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